Modality Partnership was formed in 2009 and consists of 130 partners over 50 primary care sites nationally. Our sites are spread in the following areas: West/East Yorkshire, St Helens, Birmingham, Walsall, Southeast London, Surrey, Sussex and Wokingham.

We have over 1600 members of staff. We ensure safe, effective, responsive, care and well-led services delivered in primary care. We are committed to our ‘CARE’ values:

Commitment to working with commpassion Accountablity of own actions through moderation and selflessness Respect for self and others. Vauluing difference and fairness Excellence through innovation and dedication. Embracing lifelong learning

In 2019 we were invited to become the first primary care organisation to embed the principles of the Freedom to Speak Up Guardian. We agreed to this, feeling that this embodied our CARE values to incorporate our staff views on the running of our services, and to provide a safe confidential platform for them to discuss any concerns they have. This felt like a more constructive way to obtain staff feedback, without the negative connotations associated with ‘whistleblowing’. We started by training several senior managers across the partnership to become Freedom to Speak Up Guardians and incorporate the Freedom to Speak Up principles in a Human Resources policy. We aspired to create a system where staff could approach Guardians who were not in their direct line management to ensure there was no perceived conflict of interest. Using our intranet, we were able to link Guardians with team members across the wider partnership. Since establishing our Freedom to Speak Up Guardians, we send an annual newsflash to all staff as a reminder of the role and have provided many staff with support from the Guardian’s.

The role function was disseminated to all our staff, the updated policy was circulated, and an introduction was made virtually to the team members who are our Freedom to Speak Up Guardians.

Initially we found this role difficult to embed in our practices. It was not well understood, and there was some suspicion about the intent of this role. It took time for our staff to be aware of the Guardians, and what their functions would be. Continuous reminders through our established meetings, dissemination to the senior managers by our HR team, and word of mouth promotion helped establish and embed this function. Reassurance that this was a confidential pathway, that these would be reviewed objectively, and that there would be feedback about the issues raised was well received by our staff. The principle of ‘You said; We did’ was helpful to provide assurance to our staff that issues raised would be dealt with appropriately.

We believe this role complements the work we have done towards staff wellbeing and engagement. We know that when staff feel included in decision making and can confidently report problems they come across without fear of ridicule or retribution, their wellbeing at work improves. This in turn protects against workplace burnout and stress related problems. We conduct a confidential staff survey every year, with a consistent response rate of >70%. In this we track the annual changes in staff wellbeing to include their assessment of the managerial support they receive. In our 2018 results, 19% of staff felt that the level of managerial support offered to them needed to be improved. This has reduced to 11% in 2023. This has in part been an effect of the Freedom to Speak Up Guardian function.

We have had a wide range of issues raised to the Guardians, from the identification of poor processes with the onboarding of new staff to our failure of the promotion of care to vulnerable groups in our patient population. The issues raised have been valuable learning for us and have led to improved pathways for staff and patients.

We have great pride in what we have achieved and consider this to be an essential part of our staff wellbeing programme.